Categories
Pregnancy

Insomnia During Pregnancy

Are you pregnant and dreaming of the days when you would get tired and doze off easily? Getting a calm and consistent sleep now can seem like a tall order, thanks to insomnia during pregnancy.
Insomnia is a common culprit during pregnancy, especially in the first and third trimesters.

What is insomnia?

Insomnia is lack of sleep, or the ability to maintain sleep throughout the night. According to ejog, 44.2% and 63.7% of insomnia cases occurred in the first and third trimesters, respectively.

What Causes Insomnia During Pregnancy?

In the first trimester, hormonal imbalances greatly attribute to sleep disorders. Stress also contributes to sleep deprivation. New mothers-to-be are often anxious about being a new mother, delivery, and the labor process.

Other factors responsible for restlessness include:

Diet causing stomach discomfort at night
Constant bathroom visits
Hunger
Nausea
Heartburn
Hot flashes
Dreams
Shortness of breath
Restless legs and leg cramps
Back pains
Breast tenderness

Simple Remedies for Insomnia During Pregnancy

1. Lifestyle Overhaul

Work on your diet and sleep. Incorporate the following:

• Drink lots of water during the day but limit the intake hours at bedtime. This will help you avoid frequent trips to the bathroom.

• Steer clear of coffee, strong tea, and spicy foods. Caffeine keeps you awake for long durations and limits iron ingestion for the baby. Excessively spicy foods often cause heartburn and bloating, thus keeping you awake.

• Pull the plug on screens before bedtime. The blue light from mobile screens, tablets, and televisions often affects your eyes and may keep you awake throughout the night.

• Feed to sleep. Adopt a healthy diet that won’t cause you any stomach discomfort and will facilitate seamless digestion. Try having your dinner early and refrain from going to bed while hungry. A warm glass of milk also attracts sleep greatly.

• Exercise. Be active during the day to attract sleep easily. Take a 30-45 minute walk daily, or even jog.
• Take a warm bath and have your partner massage you.
• Keep your bedroom cool, dark and quiet. Tranquil environments help to attract sleep.
• Install a meditation app on your phone to calm you down.

2. Medication and supplements for insomnia

Control your restless legs by adopting folic acid and iron-rich foods. Folic acid nourishes pregnancies by forming healthy red blood cells and lubricating the gut.

There are so many options for supportive supplements. To get recommendations based on your unique circumstances, contact us today.

3. Cognitive Behavioral Therapy

CBT helps to counter restlessness by changing ones thought cycles. CBT relaxes the mind from unnecessary stress, tension and grief. You thus consolidate your thoughts and exude positive energy all throughout.

There are many other forms of holistic modalities and therapies that may help you through insomnia during pregnancy.

Lack of sleep when expectant is ubiquitous. With minor changes, it is possible to conquer insomnia. We’d love to help.

Categories
Pregnancy

What to Expect in Your First Trimester

You’ll have a virtually invisible but amazing transformation during your first trimester. Knowing what emotional and physical changes are in store during this early time in your pregnancy can help you face them head-on. Above all, your first trimester is a time to celebrate and feel incredible.

Physical Changes

A missed period is usually the first sign that you’re pregnant, but you can experience several other physical changes coming quickly in the next few weeks of your first trimester. They include:

  • Constipation – Having higher levels of progesterone in your system will slow down how quickly food makes its way through your digestive tract, and this can cause constipation. You should add fiber to your diet to help prevent constipation, and you’ll want to drink a lot of fluid.
  • Fatigue – During your first trimester, your normal progesterone levels will spike. This will cause fatigue, and adding light exercise to a healthy diet can help minimize it. Be sure to rest as much as you can too.
  • Food Aversions or Cravings – You may develop sensitivities to certain odors and your tastes might change. You could find yourself craving odd combinations of food or not being able to tolerate things you usually love.
  • Heartburn – Hormones will cause the valve between your esophagus and stomach to relax, and this lets stomach acid get into your esophagus. As a result, you may experience heartburn. Eating frequent and small meals while avoiding fried or spicy foods can help lower the risk.
  • Nausea and Vomiting – Morning sickness usually starts the month after you become pregnant. This can be with or without vomiting. You want to drink plenty of fluids and avoid having an empty stomach to reduce how nauseous you feel.
  • Swollen, Tender Breasts – Your breasts may become sensitive or sore within the first month or two. The discomfort levels usually go down after a few weeks.
  • Urinary Frequency – You could find yourself running to the bathroom more frequently. Your blood levels increase when you’re pregnant, and the kidneys will filter extra fluid into your bladder to cause you to have to go to the bathroom more.

Emotional Changes During the First Trimester

Being pregnant can make you feel anxious, delighted, exhausted, and exhilarated. Sometimes, it may be all at one time. Emotional stress is very common with pregnant women, and it typically starts right away. You might worry about the financial impacts of a baby, your baby’s health, and how you’ll adjust to parenthood. If you currently work, you could worry about how you’ll balance your career and your family. Mood swings are very common. If your mood swings get very intense or severe, it’s a good idea to contact your health care provider.

Prenatal Care

The first visit to your doctor will focus on looking for risk factors, assessing your health, and finding out your baby’s gestational age. Your doctor will ask you specific questions about your history. You want to be honest, and your doctor will tell you about screening for chromosomal abnormalities. In conclusion, your doctor will most likely recommend check ups once every four weeks for the first 32 weeks of your pregnancy.

For a deeper level of care, education, and planning throughout your pregnancy process, contact Midwife 360. We are here to support you.

Categories
Birth

5 Benefits of a Home Water Birth

Throughout your pregnancy, the one thing that lingers in your mind often is the time of giving birth. There are a variety of birth options available today. Depending on your overall health and preference, you can choose to give birth from home, and a highly recommended method is a water birth.

Did you know today, thousands of women worldwide are choosing home water births? To find out why, keep reading.

What exactly is a home water birth? It is merely a birth that happens at home and is attended by a qualified midwife or doctor. In this case, the baby is born in the water, usually a birth pool. You may choose to labor in the water and get out to deliver, or you could decide to deliver in the water. The concept behind a water birth is that it will be gentler for the baby since it has been in the amniotic sac for nine months.

Are you thinking of having a water birth? Or are you still unsure whether it’s worth it? Let’s dive into some of the benefits of home water births to help you make an informed decision.

Benefits of a home water birth

Water births are becoming more popular each day. Wondering why? According to the American College of Obstetricians and Gynecologists, water births comes with some incredible benefits, making them a worthwhile pursuit. These benefits include:

Increased relaxation

Most women choose water births because of the relaxation benefits the water gives. How so? The answer lies in the water temperature and motion that helps in relaxation throughout the labor. Contractions usually lose their rhythm if you are tense. Once you are in the warm water, you feel relieved and relaxed, making contractions less stressful and shorter.

Being fully immersed in water also lowers your blood pressure, giving you a more relaxed feeling. Water birth is also less stressful for your baby.

Pain relief

If you want natural birth pain relief, then water birth is your friend. Many women opt to deliver their baby in the water because they won’t need pain relief medication like an epidural. Being in the warm water makes it easier for you to manage your painful contractions.

A higher sense of privacy

A birthing pool and a dimmed room is privacy on another level. Who would not feel relaxed in such a situation? Compared to bright labor wards, the ambiance in your home is significantly more comforting. Your focus is solely on labor with this form of privacy. For some people, quietness is pivotal to keeping them calm.

Increased sense of control

The water’s buoyancy effect lessens your body weight, allowing you to move freely and switch angles until you find a comfortable position. In a nutshell, being in the water makes you safer, secure, and more comfortable.

Reduced chances of episiotomy

An episiotomy is a surgical cut performed to enlarge your vaginal opening while giving birth. To avoid tearing and stitches, water birth comes in handy. It makes the perineum to be more relaxed and elastic. As a result, it reduces the incidences of tearing and enlarging the vaginal opening.

Water births present a gentler welcome to the world for you and your baby. Delivering in a birth pool comes with tons of benefits that make it a worthwhile option to consider. Benefits range from reduced labor pain and increased relaxation, to the privilege of giving birth surrounded by your loved ones.

Contact us today for more information about home water births.

Categories
Birth Healthcare Pregnancy Women's Care

Midwife360 Partners with Care Credit

Introducing Care Credit at Midwife360!

Having a natural birth at home is becoming more and more appealing as the COVID numbers grow and healthy pregnant people begin to question the automatic choice to give birth in the hospital.

However, home birth is not always covered 100% by insurance (think deductible and co-insurance) and even with Medicaid, there are some out of pocket expenses that Medicaid does not cover. With Midwife360, the lowest out of pocket amount is currently $1200 and many folks with private insurance may have to pay around $5000 when the numbers are crunched for their particular benefit plan. Our self pay rate is $6700. While even that is a small price to pay for one of the most beautiful and memorable days of your life, not everyone has that kind of cash available or even that much credit.

Enter Care Credit. Care Credit is easy to apply for and most people are approved and the staff at Midwife360 will help. It allows for a 4th option (other than cash, debit, or traditional credit card) to pay for your care without breaking the bank. Depending on the program chosen, there is an option for 6 or 12 months credit with no interest, or a low interest 24 month credit card.

Midwife360 pays a small percentage and we get paid for our services while the client gets to pay over more time for no extra cost (when choosing the no interest option).

We are happy to be able to help our clients be able to pay for their care without causing undue financial stress. Contact us today to find out more!

Categories
Pregnancy

COVID-19 and Pregnancy

This is a crazy time that we are living in. Although it is not surprising for those who have been paying attention… mono-farming crops practices are unsustainable and factory farming of animals is inhumane, fraught with horrific abuse, torture, and disregard for the ultimate health and welfare of the animals and inevitably leads to disease and negative health outcomes for the humans who eat them. Fracking, deforestation and oil pipelines have wreaked havoc on this planet and destroyed entire ecosystems on a global scale. We have endangered the oceans by our irresponsible fishing practices and despicable habit of dumping our waste in the oceans the world. Therefore, we have seen devastating fires on multiple continents.

We have been raping and pillaging the earth for a long time in the name of technology. In the name of instant gratification and utter disregard for nature. Add to this the ability of world travel for the masses. Is it no wonder, that now we have a virulent, deadly virus that spreads so easily by simple human contact? That we are plagued by a world where we have become afraid of contact with one another. Now, paranoid that an accidental bump in a grocery store or neglecting to wear gloves when pumping gas make us paranoid that we have contracted the dreaded SARS-CoV-2 virus. And could either become deathly ill or spread it to countless others by association, or both? And we are watching the numbers of those testing positive growing by leaps and bounds to nearly 1 million cases. The US now outranks the world in a number of positive cases. NY now has as many infected people as in all of China.

A Silver Lining

It appears, however, that pregnant women (contrary to what we have seen in the past with some other coronaviruses) are not getting more critical infections than other people. Elders, those with co morbid conditions (diabetes, high, blood pressure, COPD, smokers, asthmatics and those with weak lungs, maybe those who take ibuprofen, immunocompromised people, etc) would be at higher risk of contracting a critical form of illness from this virus than otherwise healthy pregnant people. Also children, other than those less than 1 year old, are less likely to get a severe form of the illness. We don’t know how it might affect fetuses in the 1st or 2nd trimesters who are exposed in the womb. But we do know that it is not found in amniotic fluid, placentas, breast milk, or cord blood of newborns. So we believe it is not transmitted from mother to baby. If common-sense precautions – such as good hand washing and wearing a mask for a parent who suspects exposure, exhibiting symptoms, or tests positive for COVID-19 – are followed, it is unlikely that an infant who co habitats with parents immediately after birth will get a critical form of sickness.

Infant Bonding and Labor Support are Human Rights

Breastfeeding confers immunity for other contagious diseases and is usually recommended as best for parent and baby. Baby’s are better able to regulate their heart rate, respiration, temperature, and blood sugar if allowed skin to skin contact and early breastfeeding. It is a birth parents right to choose rooming-in and skin to skin breastfeeding with her newborn versus handing the baby off to be “watched” in the NICU with no evidence of ill health. Evidence-based birth has a waiver you can bring with you to the hospital if pressured to release your healthy baby for separation as a COVID-19 precaution. Let’s not separate babies from their birth parent and source of best nutrition, and healthy immune and emotional newborn response.

The other parameter to watch is the restriction of support people for the pregnant person. In my opinion, based on common sense, what we know about the human Microbiome, and the laws of infectious diseases (this one in particular as it is slowly revealing its characteristics to us) is that people who cohabitate tend to share their microbiota – good and bad ones. Close contact is how this disease spreads. Assuming most people are practicing social distancing and protecting themselves and their loved ones – particularly if they are expecting a baby into the household – the pregnant persons significant other will not increase the health workers risk any more than the pregnant person herself. In fact, we know that under normal circumstances, nurses spend about 30% of the labor with the client. Having their significant other would increase the laboring persons comfort and safety by providing constant companionship helping them to the bathroom, with position changes, and overall comfort. Let’s not just have a knee jerk reaction to isolate laboring people out of fear of the unknown.

What YOU Can Do

Please socially distance yourself other than essential contact. Don’t go to the hospital unless you are having trouble breathing. Do go to a drive-through testing site or hospital if you have trouble breathing. Wear gloves and a mask if you have one, a bandana will work in a pinch. Practice generous hand washing for 20 secs and remove clothing and shower immediately upon coming home if you’ve had exposure to unknown people. Take supplements that promote a healthy immune response, and eat responsibly to encourage and support your health. Meditate and be happy, the world needs it!

Categories
Family Planning Healthcare Women's Care

Midwife360 and the Scoop on IUDs

Many of my clients ask about birth control options that do not have hormones. There are a few, mostly they are the barrier methods like condoms (male and female), diaphragms, and cervical caps, or surgery. But the copper IUD is the only one that is long term and reversible and does not have any hormones. Since the copper IUD is not the only long term, reversible contraceptive, I wanted to break it down here for you.

What is an IUD?

IUD stands for IntraUterine Device. There are 2 types of IUDs, those with hormones and those without. Both of them are T-shaped plastic rods that are about 1.3 inches long with a string attached to the leg. The ones with hormones contain progesterone impregnated plastic, while those without have some copper wrapped around the arms and/or leg. 

Progesterone IUDs

The hormonal IUDs are called Mirena, Liletta, Kyleena, and Skyla. They are approved to last from 3 to 5 years and the Mirena and Liletta can be effective up to 7 years. The Skyla (3 year device) is a bit smaller than the others and is marketed towards young women who havenʼt had babies yet. The hormones effectively thin the lining of the uterus causing the wearer to have a super light or no period. Women usually still feel that they are cycling, as they can still get bloating or other pre-menstrual symptoms, but without the bleeding. Sometimes the IUD can cause an increase in period bleeding, but this is usually short-lived and will slow down or stop completely within a few months. This can make it more difficult to get pregnant once the IUD is removed as it can be 6 months or longer before the period returns to normal. 

Copper IUDs

The copper IUD that is approved for use in the US is called Paragard. There is another brand that is used in other parts of the world called Nova-T that is the exact same thing as the Paragard – a plastic T-shaped device with 380mm2 surface area of exposed copper. The Paragard is approved for 10 years and effective for at least 12. The Nova-T package insert says itʼs approved for 5 years. 

Pros and cons

The benefit of using an IUD is that it is placed once and then you donʼt have to think about it. You donʼt have to remember to take a daily pill, switch out your patch every week, do a monthly vaginal ring swap, or get a shot every 3 months. They are very effective, partly for this very reason – everyone is a perfect user. They are considered 99% effective in preventing pregnancy.

However, if you do get pregnant, especially with a hormonal IUD, you have a greater chance of having an ectopic pregnancy (when the fertilized egg doesnʼt make it past the tube into the uterus). As mentioned above, the hormonal IUDs can lighten or stop the period which is beneficial for those with super heavy cycles or super painful cramping – such as with endometriosis (a condition where the uterine lining or endometrium grows in places outside the uterus – when she has her period these places also bleed causing extreme cramping).

Another con with the hormonal IUDs is the tendency for those with them to be unable to lose weight or gain unwanted pounds over time.

An advantage of the copper IUDs is that one gets very effective birth control without using hormones. This means that it doesnʼt affect your cycle or your ability to get pregnant once it is removed. The only other birth control that doesnʼt use hormones are the barrier devices (make and female condoms, diaphragms and cervical caps). However if one has a copper allergy, it can cause multiple systemic symptoms and even affect the efficiency of the immune system. 

Placement

When you go to have your IUD placed, you should be on your period. This helps reduce the risk of infection as you have a flow that will carry any unwanted accidentally introduced bacteria out of the uterus. It also means that your cervix is softer and more open. You will be counseled regarding the risks of perforation and infection – which are the more common risks of placement. Your provider may also mention that expulsion of the device is also possible. Perforation would be pushing the inserter through the wall of the uterus and placing the IUD outside of the uterus. 

The provider should use sterile technique and clean inside your vaginal vault with betadine or hibicleanse prior to inserting the IUD. Some providers will numb the cervix with lidocaine, which makes the insertion much less uncomfortable. The uterus should be at least 6 cm deep, which is noted during the insertion as the inserter has cm markings on it. Once the IUD is properly placed the provider will make sure to cauterize any active bleeding with silver nitrate sticks.

Then you should be given a prescription to get an ultrasound to check placement and cautioned to refrain from intercourse for one week. Having an ultrasound assures that the IUD was placed properly in case there are questions about that in the future. It also reassures everyone that there was no perforation at the time of insertion. You can feel the strings which should be about 2-3 cm long hanging out of your cervix. These strings will be used to remove the IUD when you are ready to have it taken out. 

Removal

Getting the IUD removed is typically much easier than placing it. Sometimes the strings are no longer visible in which case an instrument is used to capture them and draw them out where they can be grasped with an instrument and the IUD removed with one swift tug. It does not hurt and I donʼt think Iʼve ever removed one where the client didnʼt say “Thatʼs it? Youʼre done?” It is important to wait a couple of cycles before trying to conceive as the risk of miscarriage is higher in the first 2 cycles of stopping any type of birth control. 

Support your local Nurse Midwife!

You can see an OB/GYN or CNM to get counseled regarding which birth control option is right for you, or if an IUD is a good option for its effectiveness in treating heavy menstrual bleeding and painful periods even if you donʼt need birth control. As always – do your research, know your body, ask questions, expect respect – make sure you are satisfied with the results! 

Categories
Birth Pregnancy

Natural Sacred Birth

Natural childbirth for healthy, low-risk women is the only natural function of the human body that typically occurs in the hospital. “Why is that?”, you may ask. Because our culture has co-opted Birth, babies, and women’s bodies for the benefit of capitalism – Big Pharma, Insurance companies, and Hospitals – the Trifecta of the medical-industrial complex. That is the only reasonable explanation as Women’s bodies have been successfully birthing live babies for literally millennia – else how would we be here? Birth has only been happening inside hospitals for about one hundred years and studies have shown that it’s safer to birth outside the hospital to avoid the unnecessary interventions that lead to worse outcomes. 1,2

Doctors are taught to fear birth

Medical schools have also contributed to the situation by instilling a climate of fear surrounding Birth mostly related to potential litigation. They believe that if the doctor is taught how to control birth, then they have control over being sued. In addition, natural birth is not taught to OBs because their focus is surgery. They are surgeons; the interventions they advocate frequently lead to surgery, and this is where they shine. Obstetricians are surgeons and if you are seeking the care of a surgeon, you are likely to have surgery. Very simple.

Birth cannot be controlled

Interventions in childbirth give the illusion of control over a natural bodily function that cannot be controlled. Women’s bodies will open and release the baby inside when the body and the baby are ready. This is normal, natural childbirth in a nutshell. Even the women doing the opening and releasing have no control over the process. The only control that is possible and productive is the act of surrender to this most basic bodily function. When a woman is able to fully surrender to every aspect – when and how – then when her body and the baby are ready, it will happen. The more surrendered a woman is to the process, the more efficient it is.

Thirty-eight percent cesareans in Palm Beach County

Our community (and there are many like ours) has not embraced this principle. It is very typical for women to be induced at 38 or 39 weeks of pregnancy for a myriad of reasons. We know that when labor is induced before the body and baby are ready, then things can go wrong. The body may not fully dilate no matter how much cervical ripening is chemically encouraged or how much Pitocin is given. Often the baby will not be able to tolerate the cocktail of chemicals involved between the induction drugs and the inevitable epidural. A woman may enter the hospital wanting a natural birth, but very few are able to tolerate the torture of hours of fasting, limited mobility and abnormally strong and consistent contractions, not to mention the flow of strangers into the room, the bright lights, uncomfortable bed, etc. An epidural is the only relief she can get in the hopes of maintaining her dream of vaginal birth. Palm Beach County has an average Cesarean rate of about 38%. That’s more than 1:3 women walking into the hospital expecting a vaginal birth and ending up having surgery to have their baby!This is NOT because Birth is dangerous. This is because our community has a culture of meddling with an otherwise normal, natural process. And that meddling leads to dangerous birth.

ACOG supports VBAC

The national organizations that oversee and regulate birth providers have reasonable recommendations regarding things such as vaginal birth after cesarean and breech birth. But the local OBs tend to disregard these reasonable and evidence-based recommendations. One example of how our local OB community rejects recommendations by ACOG (American College of Obstetricians and Gynecologists, the national organization for obstetricians and gynecologists), is with VBAC (Vaginal Birth After Cesarean) candidates. ACOG recommends that doctors offer vaginal birth to women who have had 1 or 2 previous cesareans. They also don’t recommend inducing labors for VBAC candidates. Yet many OBs in our community still recommend repeat surgery for these women or insist that they birth by 39 weeks. They routinely induce VBAC candidates at 39 or 40 weeks which can lead to the very complication that they fear – a ruptured uterus. Also, there is no solid evidence that a woman with more than 2 cesareans is not a good candidate for a VBAC, but there are very few OBs that are willing to “allow” these women to attempt a vaginal birth.

ACOG supports out of hospital birth

Another example of how our community defies the national recommendations is through a document is known as The Levels of Care document that was endorsed by both ACOG and SMFM (Society of Maternal and Fetal Medicine, the obstetric specialists). In this document, it is recommended that all healthy, low-risk women birth outside the hospital in Birth Centers. If the situation changes, the woman is transferred to a higher level of care – one where the ability to perform a cesarean or other interventions such as Pitocin or epidural is available. There are even higher levels of care such as Intensive Care where caring for someone who is on life support machines is available and not all community hospitals have this option for women during or after childbirth, so she would have to be transferred from the lower level hospital to a higher one. The idea is that we have lots of birth centers, less of the community hospitals and only one or two regional centers to care for the very complicated cases. However, our local OBs do not encourage their healthy, low-risk women to birth outside the hospital. Rather, they look for reasons to elevate a woman’s risk and encourage interventions such as unnecessary inductions.

Birth is sacred

Birth is a sacred event that happens to each of us only once as we enter the world. How it happens is important for the one being born and for the one giving birth. If we are going to see a world that is healed from all of the devastations of poverty, war, climate change, and abuse it has to start with how we care for those giving birth and being born. I have grown up in my Midwifery career hearing the saying that ‘Peace on Earth begins with Birth’. We have to honor the process and respect both mother and baby by not causing pain and trauma but rather supporting, facilitating, and protecting the process. This can happen more easily out of the hospital in a woman’s home or in a birth center. However, I have not given up hope that we can shift the culture of childbirth within the hospital by spreading information and demonstrating a better way. We do this by supporting birth centers and encouraging the growth in the number of birth centers in our community.

Support the ‘birth’ of Gentle Birth Centers

I’m happy to announce the addition of a new birth center in Wellington – opening soon. Gentle Birth Centers will be teaming up with Midwife360 to create an integrated practice of home, birth center, and hospital care for healthy, low-risk candidates. We plan to open this spring and are located within a mile of the nearest hospital. Let’s change birth together!

Categories
Birth

What to Expect From a Home Birth

So you’ve decided to have your baby in the comfort of your own home. What should you expect? As a CNM who has provided home birth services for nearly 6 years, I am going to provide you with an overview of the general expectations that await you in this experience.

We visit your home 

Your provider will come to your home at least once during the prenatal period to assess home readiness for birth. We like to see that our clients have acquired all of the supplies that were recommended, including the kit of supplies that was provided by our practice. Some examples of supplies provided by the practice are sterile gauze, sterile gloves, a peri bottle, chux pads, a fish net (for pooper scooper if having water birth), a waterproof mattress cover, and potentially other items depending on the practice. The items that you are responsible for include a drinking water safe water hose, adapter for the faucet, receiving blankets for the baby and towels of various sizes, snacks for the laboring person and birth team, adult diapers or maxi pads, a waterproof covering for the floor and extra padding for under the pool. We like to see that the intended birth space is clean and clutter-free and in an intimate space where the birthing couple can get privacy if desired. It should be in close proximity to the bed and bathroom.

What happens when you go into labor? 

Once you have decided that you are in labor you will be in contact with your midwife and doula. We like our clients to set up a group text with their partner, doula, midwife and assistant so communication is transparent for all involved. This way the laboring couple are not asked the same questions by different people and everyone knows what’s going on. Typically the doula will arrive first, and if the laboring person desires a cervical check to see where things are at, the midwife or assistant will come to do a labor check. We will assess her contractions, her coping, when she last ate/drank/used the bathroom. We listen to fetal heart tones, take vitals and get an overall feel for what’s going on – including the emotional environment. 

Sometimes we have to reassure the partner more than the laboring person of the normalcy of the situation. If the cervical exam isn’t 4-6cm and the labor doesn’t seem to be progressing quickly, the midwife will leave and the doula may stay to help the couple perform some Spinning Babies circuits. Usually the doula will help to set up the tub when it’s time and let the couple know when it’s time to call the midwife back. At any point, if the couple wants the midwife to come, we will come and assess the situation.

Active Labor 

Once the laboring person is clearly in active labor, the midwife or assistant will stay and perform checks on the baby’s heartbeat and mother’s vitals on a schedule at least every half hour. We listen for a period of time through and after the contraction to get a feel for the response of the baby to the contractions. We are watching for anything outside of the normal range as well as for specific things like maternal bleeding, fever, or lack of coping. We have many tools we can employ – depending on the midwife and her range of experience. 

Our Toolbox 

We use herbs, homeopathic remedies, essential oils, posture changes, and of course, hydrotherapy. We make sure she stays well hydrated, well nourished, and well rested – these three elements are crucial to avoid exhaustion which is a laboring person’s enemy. Sometimes we use alcohol to aid relaxation and sleep if mom becomes exhausted and her labor is stalling out. Once she gets rest she is much more capable of continuing and usually the labor will pick up on its own. We have found that labor has its own waxing and waning rhythms much like each individual contraction and it works much better to flow with it rather than trying to force it to conform to some ideal pattern.

A note on hospital transferring 

If at any point along the way the laboring person changes her mind about being at home, for any reason, we will shift gears and transfer to the hospital setting. Of course we first assess if she is in transition as many people have doubts about their ability to birth in the crucial moments just before the baby makes his final descent. However, if we determine that she is no longer comfortable at home we will get her quickly into the car and to the hospital of her choice. We call ahead to give report and accompany her to the hospital.* Once there, we would stay until her care is fully transferred to her new care provider or until the baby comes if financial arrangements have been made.

Staying home 

Most people are happy to stay home as this has been something they have prepared for physically, emotionally, and spiritually, sometimes for years. Most also birth in the tub if they have rented one and are comfortable in it. 

Whether in the water or on land, baby comes out as slowly and gently as possible with lots of encouragement and coaching from the team. We have found that the slower the expulsion of the head and body, the less trauma to the mother’s vagina, labia, and perineum. Contrary to what we hear from our clients who transfer to us, we are well equipped to sew almost any tear that happens during birth. We carry Lidocaine for numbing and sutures for sewing.

“Self Starters” 

Most babies are what I like to refer to as ‘self starters’. They will spit or cough and utter a birth cry and then they are breathing. Most of them do not cry as their birth has been so gentle they have no reason to cry. We know when to employ helpful measures such as postural drainage, stimulation, rescue breaths, and suctioning and are fully equipped to perform a full on cardiac resuscitation on the newborn if necessary. 

I have seen 1 instance out of 250 home births, and 0 instances out of the over 1600 hospital births that I have assisted in my career of babies needing full on cardiac resuscitation. BIRTH IS A NORMAL, PHYSIOLOGIC FUNCTION OF A WOMAN’S BODY THAT RARELY NEEDS HELP FROM OTHERS. As long as the body is healthy with no underlying medical problems, giving birth outside the hospital is actually safer for the mom and the baby.

Post Birth Procedure 

We keep a close eye on both mom and baby right after birth, assessing vital signs and mom’s bleeding every 15 minutes or more often as needed. We carry 3 different drugs to treat hemorrhage, and one of them, methergine, we have both pill and injectable form. We will not hesitate to call 911 if there is any emergency event that requires hospital intervention. We stay for 3-4 hours after the baby is born, assessing vital signs and the baby’s transition. 

Once the placenta is birthed, we ensure that mom has eaten, showered and urinated. We perform an Eldon card so we know the baby’s blood type and can make recommendations for jaundice prevention or give Rhogam to the mom as needed for Rh negative moms. We make sure the baby is breastfeeding well and the parents are comfortable in their new roles. 

Postpartum Visits 

After the birth we make sure our clients know that they can call us for any problem with mom or baby and that we will be coming back to the house between 24-48 hours after the birth. At that visit, we perform the CCHD**, jaundice, and weight checks. We give the Vitamin K injection if the parents have chosen to have it. We would give the Rhogam shot if Mom is Rh negative and baby is Rh positive. We assess breastfeeding again and refer to the pediatrician if there are any concerns with the baby. We assess moms bleeding and comfort and any issues with depression. We return again to the home at 1 week postpartum to reassess all of the above concerns for the mother. And we will schedule the final postpartum visit at 5-6 weeks in the office to talk about family planning, pap smear schedule and any other concerns that arise.

This article gives an overview of what to expect when planning a home birth. Stay tuned for more educational articles from Midwife360!

*There have been a few instances where we have not accompanied a client to the hospital. These were rare and individual circumstances and not the normal scenarios.

** CCHD = Critical Congenital Cardiac Defect A screening test performed on the baby between 24-72 hours after birth to rule out any critical congenital heart defects.

Categories
Birth

What to Expect from a Hospital Birth

What happens when you choose to have your baby in the hospital? The specific answers to this question depend on whether you are sent there for induction or are arriving in labor. It also depends on your planned mode of birth – vaginal or cesarean. We will talk about planned vaginal birth in this article. 

Know what you’re signing for

If you arrive at the hospital for a planned induction, you will be registered for your stay, then sent to the L&D unit to check in. If they have an available room for you, you will be admitted to that room, given a hospital gown to change into and asked to leave a urine specimen in a cup. A nurse will then come in and hand you a clipboard with a stack of papers to sign. Most of them are consent forms and she has likely perfected a quick synopsis of each form. You aren’t encouraged or discouraged from reading them thoroughly, and she will answer your questions. However, this part of the intake usually goes pretty quickly – if you get my drift. The forms include consent to treat for vaginal or cesarean birth, consent for blood products, consent for Vitamin K, eye ointment, (maybe Hepatitis B vaccine, circumcision for boys, and a new eye exam that includes dilating the baby’s eye and holding it open with a metal cup). Your provider is really the one who should be giving you the risks and benefits of each intervention that you are signing for, but in reality that almost never happens.

Triage and cervical checks

If you are in active labor, unless the baby is imminently coming, you will be processed through the labor triage room where you will be given a gown and asked to leave a urine sample and get hooked up to the monitors to determine your labor pattern. Then one of the nurses (or your provider if available) will do a cervical check to see if you are at least 4 – 6 cm. You will stay depending on your contraction pattern and your cervical dilation. If your contractions are not frequent enough or lasting long enough or too long, and your dilation isn’t at least 6, you may get an ultrasound and then (if everything is good on the ultrasound) sent home. This may happen several times before you are finally admitted in labor. It is not a bad idea to stay home as long as you feel safe before going to the hospital to avoid being sent home multiple times.

When you arrive in labor, whether breathing through your contractions or feeling like pushing, the above- mentioned forms still have to be signed once you are admitted – by you, the ‘patient’. If the baby is coming and you absolutely can’t sign, they will give them to you after.  You get the idea.

So what happens when you’re admitted? 

From here on out, whether induction or active labor, everything is basically the same. After the forms, they will come in with all of the IV equipment to start your IV and draw blood. Everyone gets an IV unless you make prior arrangements with your provider, and most providers prefer you to have the IV. You are also then hooked up to the monitor with a toco that documents the timing of your contractions and an US that displays the baby’s heartbeat. 

Things you need to know

Now you are basically tied down with 2 monitor wires and an IV line which makes it difficult to get out of the bed or even change positions. Unfortunately, this goes against one of the main aspects of efficient labor – that of free movement. Even L&D nurses are getting hip to Spinning Babies – a system of postures and movement that help the baby shift into the best relationship to the mother’s pelvis for a smooth birth.

You will likely have a cervical check once you’re all settled in, and you may or may not be asked for your permission. If you are not already 6 cm or do not achieve 6 cm within a couple of hours, the provider will likely want to start pitocin to speed things up. Again, you may or may not be asked permission for this. 

Induction process 

If you are there to be induced, sometimes they start with a cervical ripening agent. In south Florida, most providers use Cervidil which is a tampon-like insert that stays in the vagina for 12 hours. Some still use Cytotec which is ¼ of a pill that is less predictable than Cervidil and can cause strong contractions that come too frequently. It has been associated with fetal intolerance and uterine rupture. You have a right to decline this. Two hours after the Cervidil is finished and taken out, they will want to start the Pitocin and break your water bag.

Here comes the epidural

Once things get rolling, if you choose to get an epidural, the anesthesiologist or Registered Nurse anesthetist will come in to evaluate you, give you the risks and benefits of the procedure and forms to sign. If you are a good candidate for the procedure, they will ask everyone to leave the room, prep and drape you and place the epidural catheter. Afterwards, they lay you flat in the bed for about 20 minutes and then you will be able to sit up and turn side to side with help, but will no longer be allowed out of the bed.

It is not impossible to do some of the Spinning Babies postures while tied to the bed or with an epidural, but it is much harder and requires a dedicated doula or very motivated nurse to accomplish them.

Once you become fully dilated you may be asked to start pushing, even if you don’t feel ready. Alternatively, if your baby is high and you don’t have a strong urge to push (or have an epidural and can’t feel that urge) you may be allowed to ‘labor down’. This refers to the process of allowing the labor contractions to bring the baby’s head down through the birth canal so that the pushing phase can be much shorter. 

Let’s talk pushing + birth

Pushing in the hospital is typically more like an athletic event with everyone yelling at you to “PUUUUSH” and instructing you to hold your breath while you push for a count of 10. You will likely have your knees up in the air with someone helping you hold your legs back. There is a definite air of adrenaline inspired action and rush to get the baby out at this point. Once the head is born, you will be told to push again to effect birth of the body and the baby may or may not be placed on your belly. Typically the cord is cut shortly thereafter and then the baby is taken to the warmer to be stimulated and dried and “eyes and thighs” (eye ointment and Vitamin K shot) are done. The baby will then be swaddled in a receiving blanket and handed to you. Some L&Ds are supporting skin to skin with the parents and may not wrap the baby up before giving him back to you. 

That is a typical hospital labor and delivery scenario. There may be individual providers that do things slightly differently, but for the most part this is the way we do it in America.

Evidence Based Birth

In general, you are not asked permission for any of the procedures and interventions that are performed in the hospital. The general idea being that you have presented yourself there so you must be ok with whatever they feel is appropriate. The truth is that most of what is done in the hospital is NOT evidence based and you would significantly benefit from educating yourself on the different possible interventions (ask your provider what the typical birth scenario looks like to her). A web resource such as Evidence Based Birth is invaluable for expecting parents whether they’ve had a baby in the hospital or are expecting their first.

Interventions 

Another trend that I’ve witnessed is the trove of interventions that are performed on the newborn – especially if she is a premie. Our hospitals and hospital providers are making A LOT of money off the backs of our most precious and fragile resource – the next generation of human beings, who cannot speak for themselves. Please educate yourselves as parents and protect your little ones from these unnecessary interventions!

*As a nurse midwife who worked in the hospital Labor and Delivery units from 2005 – 2014, both as a Labor and Delivery nurse and as a CNM, I have had a substantial amount of experience seeing thousands of women and families come through to experience the birth of their babies. Since 2008, I have worked in my own home birth practice where we have periodic exposure to the hospital L&Ds with the clients that we transfer in for one reason or another. I have not seen many substantial changes happening for the process of hospital birth, other than perhaps a nod to the delayed cord clamping movement with a reluctant delay of a minute or two or milking of the cord in some cesareans (which is now thought to contribute to brain bleeds and not such a good idea). The only real change that has occurred has been the elimination of the regular newborn nursery, and this seems to have resulted in a greater number of babies being sent to the NICU – negating the potential positive outcome of having less babies experiencing separation from their parents.

Categories
Birth

Top Ways to Prepare for a Positive Birth Experience

The top ways to prepare for a positive labor and birth experience begin long before the actual labor starts. At Midwife360, we talk about our “Recipe for Success” when we are discussing a client’s birth plans. 

The core of our recommendations include self-education through reading books and online resources (see the reading and web organization list at the end of this article) and commitment to a healthy lifestyle through clean eating and regular exercise. We strongly advise eliminating processed foods, dairy, and inorganic foods. Through clean eating and regular exercise, it is likely that there will be an absence of disease processes such as diabetes and high blood pressure which can make a pregnancy cross the line into a truly high-risk status. If the pregnancy can be maintained in the low-risk status range, then recommendations such as induction of labor are more easily declined. 

Our “Recipe for Success”

Our “Recipe for Success” also includes hiring a doula and taking a deep meditation for labor course such as Blissborn or Hypnobabies. Many times the doula will be the one who teaches these courses. Doulas are invaluable as educational resources and typically have a wealth of information regarding comfort measures and labor preparation activities. They will meet with the client usually two times prenatally and will be the first to show up at the labor. They help with labor support if things are not progressing, and will let you know when to call the midwife or leave for the hospital. Meditation or hypnosis is a tool that can be used to cope with the surges of labor. It helps to keep the mind occupied with positive thoughts to allow the body to perform the work of releasing the baby unimpeded.

Positioning of the Baby 

The most common reason that labor doesn’t progress is the positioning of the baby. We recommend becoming familiar with an online resource called “Spinning Babies” that teaches postures that can be used prenatally to help ensure proper positioning of the baby in relation to the mother’s bony pelvis. This will ease the baby’s passage and create a more efficient labor process. Your doula will most likely be familiar with this resource and have the ability to guide you through the postures as well as know when to employ them in labor.

Using a Birth Tub 

The final recommendation in our “Recipe for Success” is to use a birth tub for labor and birth. The benefits of hydrotherapy have been recognized by midwives and laboring women for years. Some people call it a ‘liquid epidural’ as the sense of relief is so great when entering a warm tub of water in active labor. Sitting on a yoga ball or stool in the shower can have some of the same sense of relief, but immersion in water is better and helps lift the belly to remove the heaviness caused by gravity. Also, releasing the baby into the water helps with vaginal and perineal stretching and reduces tearing.

Visiting a Chiropractor and Acupuncturist 

In addition to the “Recipe”, we strongly recommend developing relationships with a chiropractor and acupuncturist who are skilled in caring for pregnant people. Get regular massages and take yoga classes or do yoga at home. All of these adjunctive therapies contribute to a body that is well adjusted and free from muscular and energetic blockages that can inhibit the passage of the baby when it’s time for birth. 

Preparing for a positive labor and birth experience ideally starts before pregnancy. However, with a determined mindset and a willingness to do the work, preparation for a positive experience can easily be accomplished in the 40 weeks of pregnancy. Decide where you want to give birth and hire a care provider that you trust. Check out the resources listed below and prepare to have an amazing, informed, respectful labor and birth experience!